CERVICAL MYELOPATHY

How Common Is Cervical Myelopathy?

Cervical myelopathy emerges as a prevalent condition, recognized as the most frequent type of spinal cord dysfunction in the neck, especially among adults over 50. In the United States, approximately 5,000 to 10,000 individuals receive a diagnosis and treatment for cervical myelopathy annually, with cervical spondylotic myelopathy (CSM) as the dominant form (Nouri et al., 2015). The incidence rises with an aging population, driven by spinal wear from daily activities (Fehlings et al., 2017). Overall, persistent neck pain with neurological symptoms signals a need to consider cervical myelopathy as a potential cause.

How is Cervical Myelopathy Different?

Myelopathy stands apart from other back issues due to its impact on the entire spinal cord. Unlike localized pain from regional back problems, myelopathy affects a broad spinal cord area, potentially causing extensive nerve dysfunction. While other conditions compress specific nerve roots with localized symptoms, myelopathy leads to widespread neurological deficits, marking it as a complex spinal health concern.

What is Cervical Spondylotic Myelopathy (Degenerative Cervical Myelopathy)?

Cervical spondylotic myelopathy, or degenerative cervical myelopathy (DCM), ranks as the leading subtype of cervical myelopathy, often surfacing with age. Over time, vertebrae, intervertebral discs, and ligaments in the cervical spine wear down, reducing flexibility, thinning discs, and forming bone spurs (Kalsi-Ryan et al., 2013). These degenerative changes progressively compress the spinal cord, disrupting nerve function and amplifying symptoms like impaired coordination, weakness, and numbness in hands or arms. Timely surgical intervention often becomes necessary to relieve pressure and halt neurological decline.

Understanding the Difference Between Myelopathy and Radiculopathy

Distinguishing myelopathy from radiculopathy proves essential for spinal health management, though they may coexist:

Myelopathy:

• Cause: Results from spinal cord compression (Fehlings et al., 2017).
• Scope: Impacts the entire spinal cord, causing widespread symptoms.
• Symptoms: Includes coordination issues, muscle weakness, and bowel/bladder problems due to extensive compression.

Radiculopathy:

• Cause: Stems from compression of a specific nerve root.
• Scope: Affects localized areas linked to the pinched nerve.
• Symptoms: Features sharp pain, tingling, or numbness radiating along the nerve path, such as down an arm or leg.

In summary, myelopathy involves broad spinal cord effects, while radiculopathy stems from localized nerve root impingement, aiding accurate diagnosis and targeted treatment.

Types of Myelopathy?

Doctors categorize myelopathy into three types based on the affected spinal region:

• Cervical Myelopathy: Develops when the upper spine (C1-C7) experiences compression.
• Thoracic Myelopathy: Occurs in the mid-spine (T1-T12) of the upper and middle back.
• Lumbar Myelopathy: Arises in the lower spine (L1-L5) area.

The spine comprises four regions:

• Cervical (C1-C7),
• Thoracic (T1-T12),
• Lumbar (L1-L5),
• Sacrum and coccyx (fused bones at the base).

Cervical Myelopathy Causes

Cervical myelopathy is a progressive condition, meaning it tends to worsen over time if left untreated. The primary cause of this debilitating condition is spinal cord compression, which can occur due to several factors. Notably, severe cervical spondylosis—commonly referred to as cervical spondylotic myelopathy (CSM)—and ossification of the posterior longitudinal ligament (OPLL) are significant contributors. In OPLL, a critical ligament that connects the spinal vertebrae thickens and hardens, restricting spinal movement and function.

One of the most common forms of cervical myelopathy is cervical spondylotic myelopathy. The term “spondylotic” refers to the gradual degeneration of the spine that often comes with age, making this condition particularly prevalent in people over 50. This degeneration can manifest as cervical spinal stenosis, the narrowing of the spinal canal in the neck, which places pressure on the spinal cord. Some individuals are born with a naturally narrow spinal canal (congenital spinal stenosis), putting them at risk of developing myelopathy earlier if further narrowing occurs.

Other degenerative changes, such as bulging or herniated discs and the formation of bone spurs in the cervical spine, can also contribute to spinal cord compression. These changes progressively reduce the space available for the spinal cord, leading to the classic symptoms of cervical myelopathy.

In addition to progressive wear and tear of the spine, cervical myelopathy can occur due to hardening of the ligaments covering the brain and spinal cord. Also, the posterior longitudinal ligament hardening occurs more frequently.

The following spinal disorders can also cause cervical myelopathy

• Herniated cervical disc. A herniated disc can bulge or burst painfully. Pressure on the spinal cord or nerve roots may occur as a result of this.
• Rheumatoid arthritis. This autoimmune condition produces inflammation. The facet joints in the cervical spine can become damaged by inflammation, resulting in abnormal vertebral movement.
• Trauma. An abrupt injury, such as a vehicle accident or a sports collision, can cause the neck to hyperextend, compressing the spinal cord.
• Other cervical spine injuries, such as whiplash
• Spinal stenosis
• Spinal infections
• Spinal tumors and cancers

What happens when spinal stenosis is not treated

• Understanding the progression from untreated spinal stenosis to myelopathy necessitates a review of the effects of prolonged spinal canal narrowing. When the spinal canal narrows and is left untreated, it exerts persistent pressure on the spinal cord. Over time, this continuous pressure leads to significant spinal cord trauma. Here’s a step-by-step breakdown of the process:
  Ongoing Compression: As the canal narrows, the spinal cord is compressed. This compression disrupts the normal functioning of the spinal cord.
• Impaired Blood Flow: The consistent pressure from stenosis diminishes the blood supply to the spinal cord. Without adequate blood flow, the affected portions of the spinal cord suffer from a lack of oxygen and essential nutrients.
  Cellular Damage and Inflammation: The reduced blood flow leads to cellular damage. Dead and damaged cells trigger an inflammatory response. Inflammation, while a natural healing response, can exacerbate the situation by causing additional compression and damage if the underlying cause is not addressed.
• Functional Impairment: The combination of reduced blood flow, cellular damage, and inflammation eventually impairs the ability of the spinal cord to transmit nerve signals effectively. These nerves are crucial for controlling movements and transmitting sensory information from the limbs to the brain.

In conclusion, untreated stenosis of the spinal canal can lead to myelopathy by causing physical compression of the spinal cord, reducing vital blood flow, initiating damaging inflammatory responses, and ultimately impairing the functions of the spinal cord. This series of events highlights the importance of treating spinal stenosis early to prevent severe damage and the onset of myelopathy.

Cervical Myelopathy Symptoms

The beginning of cervical stenosis with myelopathy may go unnoticed in the early stages. For example, a tiny difference in handwriting or taking longer to get ready in the morning may become too subtle to detect. Symptoms may become more obvious over time and may involve one or more of the following:

• Hand weakness or numbness can affect grip strength. Other regions of the body, such as the arms or legs, may also suffer from these sensations.
• Typing, handwriting, buttoning a garment, and placing a key in a door may all become more difficult for the person. 
• The legs may seem heavy, or the person may find it difficult to move faster. A walking cane and/or handrails may help.
• It’s possible that pain develops in the neck or that your range of motion becomes limited as walking becomes difficult with balance issues.
• Certain motions may cause the neck to create grinding noises termed crepitus.
• Intermittent electric-shock-like pain may radiate into the arms and legs, especially while bending the head forward. Pain, tingling, weakness, and/or numbness may occur down the arm and/or into the hand if a nerve root also impinges.
• Loss of fine motor skills
• In severe cases, bowel or bladder dysfunction

These symptoms often reflect the intricate way your spinal cord supports nerves that send signals throughout your entire body. Because your nerves operate as a connected network, compression in your neck doesn’t just cause local problems; it can interfere with nerve signals that travel down the spinal cord, sometimes affecting your legs or lower body. For instance, someone may notice that their legs feel unsteady, heavy, or slow, while also experiencing difficulties with tasks that require fine motor skills in the hands.

Slight changes

In some cases, these changes are so subtle that they slip under the radar at first, like a slight delay in buttoning a shirt or a faint awkwardness in your handwriting. Over time, as the nerve signals become more disrupted, these small inconveniences can progress to more noticeable difficulties with movement, coordination, or even bladder and bowel control.

Symptoms and their evolution emerge at different times for different people. Additionally, the rate at which symptoms worsen over time may also vary. Then, symptoms may progress quickly for a while before settling down. Alternatively, the symptoms may appear gradually but consistently.

Is Neck Pain a Sure Sign of Cervical Myelopathy?

Neck pain alone does not confirm cervical myelopathy. Many individuals with this condition report no neck pain, as it often stems from muscular issues rather than neurological causes (Rao, 2015). Consulting a healthcare professional becomes crucial for ongoing neck discomfort to determine if cervical myelopathy or another condition is responsible.

Key Points to Consider:

• Varied Symptoms: Cervical myelopathy presents differently and may exclude neck pain.
• Other Causes: Muscular issues frequently cause neck pain and require exclusion.
• Professional Diagnosis: Only a doctor accurately identifies the underlying cause.

Persistent neck pain demands medical attention to ensure proper treatment.

What are the Risks of Cervical Myelopathy?

The risks of cervical myelopathy include:

• Aging: Degenerative changes in the spine, such as herniated discs or bone spurs, are common causes of cervical myelopathy in older adults.
• Trauma: Injuries to the neck or spine can cause compression of the spinal cord.
• Genetics: Some people may have a genetic predisposition to developing cervical myelopathy.

Other spinal conditions: Conditions like spinal stenosis, disc degeneration, or tumors can contribute to the development of cervical myelopathy

Diagnosing Myelopathy

Myelopathy’s most prevalent symptoms are not specific to this disorder. Unfortunately, they often mistakenly indicate other diseases. To provide an accurate diagnosis, our doctors will conduct a physical exam and prescribe imaging tests to correctly diagnose this condition. 

Diagnostic Details

Myelopathy, a serious condition affecting the spinal cord, requires precise diagnosis and effective treatment. At the Southwest Scoliosis and Spine Institute, the initial step in the management of myelopathy involves a detailed diagnosis using state-of-the-art imaging technology. This advanced imaging technology allows skilled surgeons to identify and assess the extent of spinal cord compression accurately.

The doctor will begin by conducting a thorough medical history and performing a physical exam. They will ask about your symptoms, such as neck pain, weakness, or numbness, and any relevant medical history. During the physical exam, the doctor will check your reflexes, muscle strength, and sensation in your arms and hands.

To confirm a diagnosis of cervical myelopathy, the doctor will order imaging technology to look for signs of spinal cord compression or damage. These may include:

• X-rays: This imaging test uses radiation to create images of the bones in the neck, which can show if there are any abnormalities, such as bone spurs or a narrowed spinal canal.
• Magnetic resonance imaging (MRI): This test uses powerful magnets and radio waves to create detailed images of the spinal cord and surrounding tissues. An MRI can show compression or damage to the spinal cord.
• Computed tomography (CT) scan: This test uses X-rays and computer processing to create detailed images of the spine. It will display bony abnormalities, such as spinal stenosis.
• Electromyography (EMG) and nerve conduction studies evaluate nerve function and determine if the nerves in the neck or arms appear damaged.

Once a diagnosis of cervical myelopathy is confirmed, our doctors will work with the patient to develop an individualized treatment plan based on the symptoms and underlying cause of the condition.

Diagnosing Myelopathy and Radiculopathy 

Diagnosing myelopathy and radiculopathy involves a careful and multifaceted approach. Here’s how medical professionals typically proceed:

• Physical Examination: The process often begins with a thorough physical exam. During this assessment, doctors evaluate the patient’s mobility, strength, reflexes, and sensory response to detect any abnormalities.
• Symptom Analysis: Clinicians will also delve into the patient’s medical history and analyze symptoms such as pain, numbness, or weakness. This helps differentiate between the two conditions, as myelopathy usually affects the spinal cord, whereas radiculopathy impacts nerve roots.
• Diagnostic Imaging Tests:
• X-rays: Useful for visualizing bone structure, alignment, and any degenerative changes.
• CT Scans (Computed Tomography): Provide detailed cross-sectional images of the spine, helping to identify bone spurs or herniated discs.
• MRI (Magnetic Resonance Imaging): Offers the most comprehensive view of soft tissues, including the spinal cord and nerve roots, making it invaluable for diagnosing both conditions accurately.

By combining these steps, healthcare providers can distinguish between myelopathy and radiculopathy and tailor treatment plans to the precise needs of their patients.

How Do Doctors Misdiagnose Cervical Myelopathy?

Cervical myelopathy, a condition affecting the spinal cord in the neck, often presents symptoms that overlap with other ailments. This overlap can lead to common misdiagnoses.

Misdiagnosis Scenarios:

1. Carpal Tunnel Syndrome (CTS):

Symptoms Overlap:

• • Numbness and tingling in the hands.
  • Weakness in grip strength.

Why It’s Confused:  Like cervical myelopathy, CTS affects hand dexterity, leading medical professionals to initially consider this more familiar ailment.

2. Amyotrophic Lateral Sclerosis (ALS):

Symptoms Overlap:

• • Muscle weakness.
  • Issues with coordination.

Why It’s Confused:  ALS, a serious neurodegenerative disease, shares similar initial symptoms, making it challenging to differentiate without detailed neurological exams.

3. Multiple Sclerosis (MS):

Symptoms Overlap:

• • Balance problems.
  • Difficulty with motor skills.

Why It’s Confused:  Both conditions can cause balance issues and impaired motor function, prompting misdiagnosis, especially if a patient’s medical history is not thoroughly reviewed.

Key Challenges in Diagnosis:

• Many symptoms of cervical myelopathy mimic those associated with normal aging, such as reduced hand dexterity and balance issues. This overlap can delay the correct diagnosis, as these signs are often attributed to simply growing older.
• The generality of the symptoms—numbness, tingling, and weakness—often necessitates a differential diagnosis to rule out other potential causes.

Conclusion:

Accurate diagnosis of cervical myelopathy requires careful consideration of a patient’s entire symptom profile and thorough neurological examinations to distinguish it from other similar conditions like carpal tunnel syndrome, ALS, and MS. Highlighting the nuances and advancing diagnostic techniques can prevent delays and ensure appropriate treatment.

Managing and Treating Myelopathy?

The two main types of treatments for cervical myelopathy are non-surgical and surgical procedures.

Customized Treatment Approaches

Following diagnosis, the medical team at The Southwest Scoliosis and Spine Institute designs a personalized treatment plan. This plan focuses on relieving the pressure on the spinal cord, a key factor in halting the progression of myelopathy and enhancing neurological function. The array of surgical procedures available at the Institute is targeted to precisely address the specific conditions causing spinal compression. Each technique aims to provide significant relief and improve the patient’s quality of life.

The main goal of surgery is to stop the worsening of spinal cord injury and prevent permanent disability. Recovery from myelopathy depends on the severity of symptoms and how long the cord was compressed before surgery was performed. You may regain modest improvement in hand function and walking, although numbness may persist. Residual problems after surgery may take several months to resolve.

Additionally, rehabilitation methods such as gait and balance re-training may optimize recovery. These comprehensive approaches ensure that patients receive tailored treatment plans that not only address the immediate issue but also support long-term health and mobility.

For decades, the expert spine surgeons at the Southwest Scoliosis and Spine Institute have been pioneering techniques that offer patients renewed hope and mobility. Their dedicated approach combines thorough diagnosis with innovative surgical treatments tailored to the unique needs of each patient.

Here’s a breakdown of the common non-surgical and surgical procedures:

Can Cervical Myelopathy Be Cured?

Cervical myelopathy is a complex condition, and while a full cure may not always be possible, significant improvement is often achievable—especially with timely intervention. Surgical procedures performed at the Southwest Scoliosis and Spine Institute are designed to relieve spinal cord pressure, halt the worsening of symptoms, and prevent further neurological decline. However, it’s important to understand that some changes caused by long-term compression, especially numbness or weakness, may persist even after surgery.

Ongoing care—including physical therapy, medications, and tailored rehabilitation—plays a crucial role in maximizing mobility and function. Many patients experience notable gains in hand use, balance, or walking, though age-related wear and tear can continue to affect the spine over time. With personalized treatment and vigilant follow-up, most individuals find their symptoms are well-managed, enabling them to maintain a fuller, more active lifestyle.

Non-Surgical Procedures:

• Medications: Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and corticosteroids manage pain and inflammation associated with cervical myelopathy.
• Physical therapy: Physical therapy will improve the range of motion, strengthen muscles, and relieve pressure on the spinal cord. This can help alleviate symptoms such as pain and weakness.
• Cervical traction: Cervical traction is a non-surgical procedure that uses a device to gently stretch the neck and relieve pressure on the spinal cord. This can help improve symptoms such as neck pain and tingling in the arms.
• Bracing: In some cases, a cervical collar or brace will help immobilize the neck and reduce pressure on the spinal cord.

Surgical Procedures:

• Anterior cervical discectomy and fusion (ACDF): ACDF is a surgical procedure that involves removing the damaged or herniated disc in the neck and fusing the adjacent vertebrae. This can help alleviate pressure on the spinal cord and improve symptoms such as pain and weakness.
• Cervical laminectomy: Cervical laminectomy is a surgical procedure that involves removing the lamina, or the bony arches of the vertebrae, to create more space in the spinal canal. For instance, this can help relieve pressure on the spinal cord and improve symptoms such as numbness and tingling in the arms.
• Artificial disc replacement: In this surgical procedure, the damaged disc in the neck is removed and replaced with an artificial disc. This can help maintain spinal flexibility and alleviate symptoms such as neck pain and stiffness.
• Posterior cervical laminoplasty: This procedure involves creating more space in the spinal canal by repositioning the vertebrae without removing the bone. This can help alleviate pressure on the spinal cord and improve symptoms such as numbness and weakness in the arms.

When to Seek Medical Attention

If you notice symptoms consistent with cervical myelopathy—such as weakness, numbness, trouble with coordination, or changes in bladder or bowel control—it’s essential to visit a healthcare provider. Prompt evaluation can determine if there’s compression on your spinal cord, allowing for timely intervention. Even after a diagnosis, stay in close contact with your provider: let them know if your symptoms worsen or if you experience any side effects from treatment. Early and proactive care is key to preserving function and quality of life.

What Questions Should You Ask Your Healthcare Provider About Cervical Myelopathy?

When discussing cervical myelopathy with your doctor, it’s important to be thorough in your understanding of your diagnosis and treatment plan. Here are some questions you might consider asking during your visit:

• Can you explain exactly where in my cervical spine the compression is occurring?
• What are my options for both non-surgical and surgical treatments?
• How will these treatments relieve symptoms or improve my function?
• What side effects or risks are associated with the recommended treatments?
• If surgery is necessary, what does the procedure involve, and what should I expect during recovery?
• Are there lifestyle changes, physical therapy, or activities I should avoid to protect my spine?
• How will my condition be monitored moving forward—will I need additional imaging or follow-ups?
• Am I at risk for future episodes or complications involving my spine?

Open communication helps ensure you receive care tailored to your needs and gives you the information needed to make confident decisions about your health.

How Quickly Does Myelopathy Progress?

The progression of cervical myelopathy can vary greatly depending on its underlying cause. In some cases, symptoms may develop suddenly, such as after an accident or trauma to the neck. More often, however, the condition progresses slowly over time as a result of age-related changes in the spine or chronic wear and tear. Your healthcare provider will assess your symptoms along with any imaging results to help predict how quickly your myelopathy may advance and to evaluate your risk of complications.

If you notice any signs of weakness, numbness, or difficulty with coordination, don’t delay in seeking medical advice. Acting early can make a significant difference in both the speed and quality of your recovery.

This makes understanding the specific causes behind spinal compression crucial, as it guides the therapeutic approaches and interventions necessary for effective management and recovery.

Understanding Posterior and Anterior Approaches for Cervical Myelopathy Surgery

Cervical myelopathy is a progressive condition, meaning it tends to worsen over time if left untreated. While some symptoms may temporarily improve with conservative treatments like physical therapy or medications, the underlying spinal compression usually requires more definitive treatment.

The nerves that govern bodily motions and functions can become damaged by spinal compression. Because doctors cannot reverse nerve damage, it is critical to get treatment as soon as symptoms appear. Early detection and therapy can help you improve your health and, in some cases, reverse spinal cord injury.

Cervical Myelopathy Often Requires Surgical Intervention.

Two primary surgical approaches are used: Posterior and anterior.  Here is a detailed comparison of these methods

Posterior Approach

Targeted Procedures:

• Laminoplasty: This procedure involves widening the spinal canal. It is particularly beneficial for preserving the natural motion of the spine.
• Decompression Surgery: Sometimes combined with spinal fusion, this surgery removes bone spurs, herniated discs, or ossified ligaments from the back of the neck. Spine fusion is then used to stabilize the affected area.

These posterior approaches are designed to relieve pressure on the spinal cord while either maintaining or restoring stability. Depending on the specifics of your condition, your doctor may recommend a posterior procedure like laminoplasty if preserving spinal motion is a priority, or opt for decompression with fusion when greater stability is needed after removal of problematic tissue.

Other Surgical Approaches

While many surgeries are performed from the back of the neck (posteriorly), some conditions are better addressed from the front (anteriorly). The choice between the anterior and posterior approach depends on the location and severity of compression, as well as individual patient factors. Your surgical team will recommend the most suitable option based on your unique situation, ensuring the best possible outcome for your spinal health.

Surgical Access:

• Operates the back of the neck, providing direct access to the spinal canal and nerve roots.

Recovery and Outcomes:

• Generally, a longer recovery period is required due to more extensive muscle cutting.
• Potential for more post-operative pain initially, but can be effective for multiple levels of spinal stenosis.

Anterior Approach

Targeted Procedures:

• Discectomy: Removal of herniated discs directly pressing on the spinal cord.
• Corpectomy: Removal of the vertebral body and adjacent discs to relieve compression, often followed by fusion to stabilize the spine.

Surgical Access:

• The operation is performed from the front of the neck, allowing easier access to the vertebral bodies and discs without disturbing the major muscles of the back.

Recovery and Outcomes:

• Typically, a shorter recovery period and less initial post-operative pain.
• Direct access can lead to thorough decompression with less trauma to the surrounding tissues, but it might not be suitable for multi-level decompressions.

Deciding Factors

• Severity and Location of Compression: Anterior might be preferred for front-side spinal cord compression, whereas posterior approaches can be better for issues affecting multiple spine levels.
• Patient’s Health and Anatomy: Surgeon’s experience and the patient’s specific anatomy will heavily guide the choice.
• Surgeon’s Recommendation: Based on the above factors, your healthcare provider will recommend the most appropriate approach.

In summary, the posterior and anterior surgical approaches for treating cervical myelopathy differ in their surgical pathways, specific procedures, and recovery implications. Discussing with your specialist about which method suits your condition will ensure the best outcomes.

Understanding Anterior Corpectomy & Fusion

Anterior Corpectomy & Fusion is a surgical procedure aimed at relieving spinal cord or nerve compression caused by factors such as bone spurs or other degenerative changes.

Key Steps Involved:

• Removal of Vertebra: The surgeon removes portions of the vertebral body along with the intervertebral discs. This is more extensive than the more common Anterior Cervical Discectomy and Fusion (ACDF), which typically focuses only on disc removal.
• Placement of a Cage or Graft: To fill the resultant gap, a large titanium cage or structural graft (often a strut graft) is inserted. This provides necessary support to the spine.
• Stabilization: The cage or graft is then secured using metal plates and screws, ensuring the stability of the spine during the healing process.

Indications for the Procedure:

• Multiple vertebrae are affected by bone spurs.
• Significant compression on the spinal cord or nerves due to vertebral bone issues.

This approach helps in providing relief from pain and preventing further neurological impairment by addressing extensive spinal degeneration or deformity.

Understanding Posterior Cervical Laminectomy & Fusion

Posterior cervical laminectomy & fusion is a surgical procedure aimed at relieving spinal cord compression and stabilizing the neck. Here’s a breakdown of what this procedure involves:

• Incision and Exposure: The surgeon starts by making an incision at the back of the neck. The muscles surrounding the spine are carefully moved aside to reveal the bony lamina, which forms part of the vertebral arch.
• Removal of the Lamina: The next step involves removing the bony lamina. This opens up the spinal canal, allowing the surgeon to access the spinal cord.
• Decompression: Any overgrown ligaments and herniated disc material causing compression on the spinal cord are meticulously removed. This alleviates the pressure on the spinal cord.
• Screw Placement: Screws are inserted into the lateral masses, which are the side portions of each vertebra. These screws prepare the spine for the fusion process.
• Fusion Bed and Graft: A fusion bed is then prepared to accommodate bone graft material. This material promotes the fusion of the vertebrae, aiding in stable healing.
• Rod Connection: Finally, rods are attached to the screws on both sides of the spine. These rods provide additional support and proper spinal alignment during the fusion process.

By understanding these steps, you can grasp how posterior cervical laminectomy & fusion work to alleviate pain and improve spinal stability.

It’s important to note that the choice of treatment for cervical myelopathy depends on several factors. For instance, the severity of symptoms, age, general health, and underlying cause of the condition. Also, our doctors will assess all of these factors and recommend the most appropriate treatment for each patient.

Surgery may be considered if you’re experiencing severe pain, significant muscle weakness, noticeable numbness, challenges with balance and walking, or difficulty with fine motor skills.

What Treatments Are Available for Radiculopathy?

Radiculopathy, commonly referred to as pinched nerve pain, can be addressed through multiple treatment options, depending on the severity of the condition and the specific needs of the patient. Here’s a breakdown of available treatments:

Medication Options

• Pain Relievers: Non-prescription pain relievers like ibuprofen and acetaminophen can help alleviate mild to moderate discomfort.
• Prescription Medications: In more severe cases, doctors might prescribe stronger pain relievers or muscle relaxants.

Therapeutic Approaches

• Physical Therapy: A tailored physical therapy program can strengthen muscles, improve flexibility, and reduce pressure on the affected nerve.
• Chiropractic Care: Chiropractic adjustments may help relieve nerve compression and improve spinal alignment.

Surgical Interventions

• Microdiscectomy: This minimally invasive procedure involves removing portions of a herniated disc to relieve nerve pressure.
• Laminectomy: In this surgery, part of the vertebral bone called the lamina is removed to create more space for the nerve.
• Spinal Fusion: This procedure permanently connects two or more vertebrae, eliminating movement between them to reduce pain.
• Disc Replacement: An artificial disc replaces a damaged one, allowing more natural motion compared to a spinal fusion.

Alternative Treatments

• Acupuncture: Some patients find relief through acupuncture, which involves inserting thin needles into specific points on the body.
• Massage Therapy: Therapeutic massage can help alleviate muscle tension and reduce nerve compression.

Lifestyle Modifications

• Exercise: Regular, low-impact exercises, such as walking or swimming, can help maintain a healthy weight and reduce spinal pressure.
• Ergonomic Adjustments: Using ergonomic furniture and tools can help maintain proper posture and reduce strain on the spine.

Each treatment option comes with its own set of benefits and potential risks. It’s crucial to consult with healthcare professionals to determine the most appropriate course of action for your specific condition.

What Types of Rehabilitation Might Help After Cervical Myelopathy Surgery?

After undergoing cervical myelopathy surgery, patients often require a comprehensive rehabilitation program to ensure optimal recovery. Here are some types of rehabilitation that may help:

Physical Therapy:

• Focuses on gait training to improve walking ability.
• Balance exercises to reduce the risk of falls.
• Strengthening exercises aimed at building muscle support around the spine.
• Flexibility routines to maintain and improve the range of motion.

Occupational Therapy:

• Helps patients regain the ability to perform daily activities, such as dressing, bathing, and cooking.
• Adaptation strategies and modifications to the home environment for safety and ease.

Speech Therapy:

• In some cases, surgery can affect swallowing and speech, necessitating targeted therapy.

Pain Management:

• Techniques like transcutaneous electrical nerve stimulation (TENS) and acupuncture.
• Medication management with a focus on reducing reliance on opioids.

Neurological Rehabilitation:

• Addresses specific nerve-related issues, including numbness and motor skill difficulties.
• Techniques like mirror therapy and neuromuscular re-education.

Psychological Support:

• Counseling and support groups to help cope with emotional and mental health challenges post-surgery.
• Recovery is a multifaceted process that goes beyond merely healing the surgical site. A tailored rehabilitation plan that includes these approaches can significantly improve the quality of life and overall outcomes for those recovering from cervical myelopathy surgery.

What is the Recovery Process After Cervical Myelopathy Surgery?

Recovering from cervical myelopathy surgery involves several stages and varies greatly depending on the severity and duration of the spinal cord compression before the procedure.

Initial Recovery Phase

The primary goal of the surgery is to halt the progression of the Cervical spinal cord injury and prevent permanent disability. Early postoperative recovery often focuses on reducing pain and enabling basic movements. During the first few weeks post-surgery, you might experience some improvements in hand function and walking. However, symptoms like numbness may linger for a while.

Long-Term Rehabilitation

Recovery doesn’t stop after the initial healing phase. It often spans several months and includes specialized rehabilitation techniques. Physical therapy is crucial and typically includes:

• Gait Training: To improve walking ability and balance.
• Strength Exercises: To rebuild muscle strength around the affected areas.

These activities help maximize the recovery of motor functions and ensure you regain as much independence as possible.

Persistent Symptoms and Adjustments

While some symptoms improve relatively quickly, others may take longer to resolve. For some individuals, permanent lifestyle changes may help to recover faster:

• Residual Issues: Persistent numbness or weakness may need ongoing management.
• Self-Care Skills: Learning skills like self-catheterization and stress management can help in daily life.
• Modified Duties: If fully returning to previous activities isn’t feasible, you might have to adapt to lighter duties or modified roles in your daily routine.

Support Systems

Physical therapists play a significant role in the recovery process by guiding you through exercises and offering techniques for managing pain and stress. Regular consultations with your physician are essential to monitor progress and adjust rehabilitation plans as needed.

Overall, the recovery process after cervical myelopathy surgery is multifaceted, involving immediate postoperative care, long-term rehabilitation efforts, and sometimes adapting to new ways of living.

Cervical Myelopathy Surgical Intervention and Emerging Treatments

Surgical intervention, such as decompression or spinal fusion, often becomes necessary to alleviate pressure on the spinal cord and prevent further progression of symptoms (Fehlings et al., 2017). With timely and appropriate treatment, many individuals with cervical myelopathy experience significant improvement in symptoms and quality of life (Nouri et al., 2015).

In addition to established surgical approaches, recent research explores potentially groundbreaking pharmacological treatments. A medication, currently under study, aims to aid spinal cord recovery after injury or surgery (Ahmad et al., 2020). Preliminary findings from animal studies suggest this medicine may enhance recovery from compression and post-surgical outcomes (Smith et al., 2022). This promising research indicates that future protocols could combine surgical and drug therapies to optimize patient outcomes for cervical myelopathy.

Further investigations remain essential to confirm this new medicine’s efficacy in humans. However, integrating this medication into treatment strategies represents a significant potential advancement in managing cervical myelopathy, offering hope for enhanced recovery experiences (Kalsi-Ryan et al., 2013).

Myelopathy Prevention

Myelopathy is not always preventable, often resulting from typical aging, wear, and tear (Rao, 2015). You can reduce the risk by strengthening and caring for your spine with these strategies:

• Lift Heavy Objects Safely: Bend at the knees, tense stomach muscles, and rise with legs. Seek assistance if lifting alone proves difficult (American Academy of Orthopaedic Surgeons, 2022).
• Maintain a Healthy Weight: Extra weight strains the spine, increasing risk (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2021).
• Stop Smoking: Smoking accelerates spinal disc degradation (Deyo, 2007).
• Strengthen Back and Core Muscles: Crunches, planks, and Pilates enhance spinal support (Fehlings et al., 2017).

The Prognosis for Myelopathy Patients?

Cervical myelopathy progresses over time if untreated (Nouri et al., 2015). Some symptoms may temporarily improve with conservative treatments like physical therapy or medications, but spinal compression often demands definitive intervention (Kalsi-Ryan et al., 2013). Spinal compression damages nerves governing bodily motions and functions. Since doctors cannot reverse nerve damage, early treatment proves critical (Fehlings et al., 2017). As mentioned earlier on this page, timely detection can improve health and, in some cases, reverse spinal cord injury.

Surgical intervention, such as decompression or spinal fusion, often becomes necessary to alleviate pressure and halt symptom progression (Fehlings et al., 2017). With timely treatment, many patients experience significant symptom relief and improved quality of life (Nouri et al., 2015).

Life Expectancy and Quality of Life

Life expectancy for cervical myelopathy patients remains generally unaffected, especially in mild cases (Rao, 2015). However, untreated or severe cases lead to progressive neurological deficits, including permanent nerve damage or rare paralysis, impacting overall health and quality of life (Fehlings et al., 2017).

Each person’s outlook varies based on symptom severity, general health, and age (Kalsi-Ryan et al., 2013). Early diagnosis and treatment manage symptoms, improve outcomes, and preserve independence and mobility. Some individuals stabilize or improve symptoms, while others face ongoing challenges if intervention delays occur.

Consulting healthcare providers for personalized advice ensures the most effective course of action, tailored to individual needs (American Academy of Orthopaedic Surgeons, 2022).

Why Choose the Southwest Scoliosis and Spine Institute

The doctors, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, specialize in all types of spine conditions, deformities, and scoliosis pain, and who focus on diagnosing and treating scoliosis and other complex spine conditions, including spine and revision surgery for children and adults.

At our practice, we encourage people to get checked early on for neck pain.  In the majority of cases, our findings are minor. However, in certain cases, early detection and treatment can have a positive effect on the future decades of a wonderful life. There are many reasons why you should choose the Southwest Scoliosis and Spine Institute to treat your lumbar spinal scoliosis. Here are a few:

• They have a team of experienced and board-certified surgeons who specialize in treating spinal conditions, including scoliosis.
• They offer a variety of treatment options, including non-surgical and surgical treatments.
• They have a state-of-the-art facility that is equipped with the latest technology for diagnosing and treating spinal conditions.
• They have a reputation throughout the Nation for providing the very best spinal care for their patients.
• They are conveniently located in three locations in Dallas, Plano, and Frisco, Texas.

Finally, if you are considering treatment for cervical myelopathy, we urge you to schedule an appointment with the Southwest Scoliosis and Spine Institute. So pick up the phone today and give us a call. At the appointment, the doctors can help you understand your condition and develop a treatment plan that is right for you.

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Citation: National Institute of Health – Cervical Myelopathy

The medical content on this page has been carefully reviewed and approved for accuracy by the Southwest Scoliosis and Spine Institute’s qualified healthcare professionals, including our board-certified physicians and Physician Assistants. Our team ensures that all information reflects the latest evidence-based practices and meets rigorous standards of medical accuracy, with oversight from our expert spine doctors to guarantee reliability for our patients.